- 34-4 Table of Contents [PDF]
Ankle Arthrodesis with Hindfoot Nail and Fibular Strut Autograft as a Limb-salvage Procedure in Patients with Talar Bone Loss - Mark Smith, MD; Jan Szatkowski, MD; and Anthony Sorkin, MD
| A novel technique for hindfoot arthrodesis using distal fibula strut autograft for talar bone loss is described. A case series of six patients who underwent the novel procedure is presented. Six patients were retrospectively evaluated with traumatic talar injury and subsequent avascular necrosis (AVN) who underwent reconstruction with a novel technique. The primary outcome studied was the rate of radiographic union. Five of the six patients with sufficient follow-up achieved radiographic union. Traumatic talar injury that leads to AVN/pos"raumatic arthritis can be successfully reconstructed with an ipsilateral fibular strut autograft and retrograde ankle arthrodesis nail through the graft. More studies are needed to determine the efficacy of the procedure, including studies with increased power and studies with long-term follow-up. However, the authors propose that this novel technique is a promising option for limb salvage in patients with talar bone loss. (Journal of Surgical Orthopaedic Advances 34(4):211–214, 2025)
Key words: talus, avascular necrosis, ankle, fusion, autograft, hindfoot
Quality of Information About Shoulder Arthroplasty in Videos on YouTube - Sai Kamma, BS; Sanjana Janumpally, BS; Bradley M. Nus, BSA; Trey R. Sledge, BS; Grant Torres, BS; Kylie Wu, BSA; Patrick A. Naeger, MD; and Jeremy S. Somerson, MD
This study evaluates the quality and reliability of shoulder arthroplasty videos available on YouTube. Using the search terms “shoulder arthroplasty,” “total shoulder arthroplasty,” “partial shoulder arthroplasty,” and “shoulder arthroplasty procedures,” the authors found a total of 150 videos; 91 were assessed, and 82 met inclusion criteria. Two independent reviewers evaluated each video for educational content quality. Further analysis was undertaken using the following variables: upload date; total view count; duration; number of likes, dislikes, and comments; source; and modality. The included videos had an average Global Quality Scale (GQS) score of 2.95, indicating subpar educational content quality. Patient testimonials (10%) scored the lowest average GQS (1.8), while physician-led presentations (26%) scored the highest (3.5). There was no significant difference in average GQS between videos with a higher versus lower view count, or average GQS and days since upload. Most shoulder arthroplasty videos on social media provide low-quality information for patients. (Journal of Surgical Orthopaedic Advances 34(4):163–167, 2025)
Key words: communication, decision making, education of patients, operative surgical procedures, shoulder replacement arthroplasty, social media
Effects of Metacarpophalangeal Arthrodesis on Thumb Ligament Reconstruction Tendon Interposition Arthroplasty Outcomes - Jonathan Bryant, DO; William Currie, PhD; Eric Taris, DO; and Jeffrey Marchessault, MD
Patients undergoing thumb ligament reconstruction tendon interposition (LRTI) for carpometacarpal (CMC) arthritis are often treated with metacarpophalangeal (MCP) arthrodesis for concomitant MCP hyperextension. The effects of MCP arthrodesis on LRTI were evaluated in this study. Thirty-one LRTI surgeries were compared to 22 LRTIs with MCP arthrodesis surgeries. All patients answered Michigan Hand Outcomes (MHQ), QuickDASH, and Visual Analog Score (VAS) questionnaires. Grip, tip pinch, lateral pinch and opposition were measured. The LRTI alone and LRTI with MCP arthrodesis cohorts were then compared to each other and all of the non-operative thumbs of the same patients. The LRTI and MCP arthrodesis group showed no statistical difference in MHQ, QuickDASH, VAS, or measured strength compared to LRTI alone. This study shows no difference in patient reported outcomes between patients with LRTI alone and LRTI with MCP arthrodesis performed by the same surgeon on average 4 years after surgery. (Journal of Surgical Orthopaedic Advances 34(4):168–173, 2025)
Key words: hand, wrist, thumb, arthritis, carpometacarpal (CMC), metacarpophalangeal (MCP)
Patients With Chronic Obstructive Pulmonary Disease Undergoing Total Ankle Arthroplasty Have Shorter Operative Time and Longer Hospital Length of Stay - Albert T. Anastasio, MD; Billy Kim, BS; Emily Peairs, BS; Kian Bagheri, BA; and Samuel B. Adams, MD
There is a dearth of studies analyzing outcomes in patients with chronic obstructive pulmonary disorder (COPD) receiving total ankle arthroplasty (TAA). The present study aimed to compare preoperative characteristics and 30-day postoperative outcomes for patients with COPD undergoing TAA. The National Surgical Quality Improvement Program (NSQIP) database was queried for primary TAA (CPT: 27702) from 2012 – 2020. Baseline comorbidities were compared using univariable statistics and subsequently multivariable regression was performed to measure the effect of COPD on operative time, LOS, and 30-day readmissions after TAA. In a sample of 1,619 total patients, on multivariate regression, COPD was found to be an independent risk factor predictor for shorter operative time ( b = -0.33; p = 0.037), and hospital LOS (b = 0.37; p = 0.039). In conclusion, it was determined that COPD is an independent risk factor for shorter operative time and increased duration of hospital length of stay in patients undergoing TAA. Clinical level of evidence: Level III. (Journal of Surgical Orthopaedic Advances 34(4):174–177, 2025)
Key words: total ankle, COPD, total ankle arthroplasty, hindfoot, ankle
A Cross-sectional Analysis of the Femoral Neck System From Medical Device Reports: A National Database Study - Colin Campbell, DO; Petros Koutsogiannis, DO; Kevin Chang, MD; Nicholas R. Piniella, BS; Michael Katsigiorgis; John M. Tarazi, MDand Gus Katsigiorgis, DO
The Femoral Neck System (FNS) offers high resistance against angular instability and femoral head rotation by simultaneously remaining minimally invasive. This study reports the complication profile of FNS in real-time to assess the risk-benefit of this device. The Manufacturer and User Facility Device Experience (MAUDE) nationwide database was used to identify complications related to the FNS between January 1, 2018 and January 1, 2022. Data collected included the date the reports were received by the FDA, the type of complication, event description, and the source of report. Of the 182 complication entries reported, 67.5% of the complications were related to the FNS, and 94.5% were classified as an injury. The most common reported type of complication was peri-implant fracture (25.8%; 47 entries), of which, 36 entries were specified as subtrochanteric fracture. This study suggests that the FNS offers excellent construct stability; however, potential stress risers in the subtrochanteric region can be formed and predispose patients to peri-implant fractures. (Journal of Surgical Orthopaedic Advances 34(4):178–181, 2025)
Key words: femoral neck system, trauma, complication profile, MAUDE database
COVID-era Delayed Time to Surgery for Emergent Orthopaedic Procedures - G. Jacob Wolf, MD; Charles Johnson, MD; Langdon Hartsock, MD; and Kristoff Reid, MD
Surgical specialties experienced significant changes during the COVID-19 pandemic including new preoperative testing protocols and altered perioperative workflows, which this study hypothesized led to delays in care for emergent orthopaedic cases. Operative cases performed between January 1, 2019 to March 7, 2021 were identified, with a threshold date separating pre- COVID-era from COVID-era of March 1, 2020. Demographics, perioperative timing, and COVID testing data were examined for 308 pre-COVID and 353 COVID-era cases with posted urgency classification of level 1, 2, or 3. Pre-COVID cases averaged shorter time-to-surgery compared to COVID-era, while even COVID-negative patients saw significantly prolonged times during the COVID-era. There were no significant differences in time-to-surgery between COVID-positive and COVID-negative patients, but COVID-positive patients saw significantly longer post-procedure operating room times during the COVID-era. Emergent orthopaedic surgical cases experienced significantly greater delays in time to procedure start during the COVID-era than cases with the same level of urgency in the pre-COVID-era. (Journal of Surgical Orthopaedic Advances 34(4):181–184, 2025)
Key words: COVID, time-to-surgery, orthopaedic surgery, preoperative protocol
Accuracy of MRI to Detect Lateral Ulnar Collateral Ligament Tears - Austin Murphy, MD; Tyler Brolin, MD; David Bernholt, MD; Frederick Azar, MD; and Thomas Throckmorton, MD
The objective of this study was to determine accuracy of magnetic resonance imaging (MRI) in detecting lateral ulnar collateral ligament (LUCL) tears. In this retrospective cohort study, two shoulder and elbow surgeons performed blinded review of preoperative MRIs to determine the presence of complete LUCL tears. Consensus interpretations were compared with operative reports. Fifty-nine patients were identified, 11 with LUCL tears confirmed intra-operatively. Sensitivity of the two observers and original radiologists was 90.9%, 90.9%, and 72.7, and specificity was 81.3%, 91.6%, and 97.9%, respectively. Combined consensus sensitivity and specificity of MRI in detecting LUCL tears was 100% and 95.8%, respectively. Inter-observer reliability was moderate (k = 0.54). Positive predictive value and negative predictive value were 84.6% and 100%, respectively. Overall accuracy was 96.6%. Clinical interpretation by shoulder and elbow surgeons results in moderate inter-observer agreement for diagnosis of complete LUCL disruption. Despite modest positive predictive value, data indicate high accuracy, sensitivity, specificity, and negative predictive value using MRI to detect LUCL tears. Level of Evidence: Level III Diagnostic. (Journal of Surgical Orthopaedic Advances 34(4):185–187, 2025)
Key words: elbow, lateral ulnar collateral ligament tears, magnetic resonance imaging, accuracy, sensitivity, specificity
Computer Navigated Unicompartmental Knee Arthroplasty is Reimbursed Less than Conventional Methods While Improving Component Alignment - John C. Bonano, MD; Abiram Bala, MD; James I. Huddleston III, MD; William J. Maloney, MD; Stuart B. Goodman, MD, PhD; and Derek F. Amanatullah, MD, PhD
Computer navigation improves component alignment in total and partial knee arthroplasty, but the impact of improving the alignment of implants on survival and clinical outcomes remains unclear. In addition, there is concern about the cost associated with using a computer navigation in the current healthcare economic climate. Despite these concerns, li!le is known about the reimbursements for unicompartmental knee arthroplasty at both the index and 90-day global periods. Using a large database analysis, the authors asked (1) what is the utilization per year of both conventional unicompartmental knee arthroplasty (UKA) and computer-navigated UKA (CN-UKA) from 2007 to 2016? (2) What are the Medicare reimbursements for both conventional UKA and CN-UKA at the index and 90-day global periods from 2007 to 2016? Four hundred and seventy-five CN-UKAs were matched to 1,887 conventional UKA controls. The mean index reimbursement for CN-UKA was $11,769 ± $8,558. This was $2,706 lower (95% confidence interval [CI] $1,801 – $3,610) than that of conventional UKA ($14,475 ± $9,073, p < 0.001). The mean 90- day global reimbursement for CN-UKA was $17,220 ± $13,630. This was also $2,071 lower (95% CI, CI $857 – $3,288) than that of conventional UKA ($19,292 ± $11,645, p < 0.001). CN-UKA is associated with decreased total reimbursements compared with conventional UKA at the time of index surgery as well as over the 90-day global period. Payers are not recognizing the value of navigation in UKA, despite clear improvements in radiographic alignment and similar survival and functional outcomes. Without equal reimbursements and long-term studies to show its potential impact on clinical outcomes that will convince the payer of its value to the healthcare system, the economic viability of CN-UKA is in jeopardy. The level of evidence is Level III, therapeutic study. (Journal of Surgical Orthopaedic Advances 34(4):188–192, 2025)
Key words: unicompartmental knee arthroplasty (UKA), partial, navigation, reimbursment
Variable Axial Rotation is Needed to Achieve a Balanced Flexion Gap in Total Knee Arthroplasty - Jessica M. Hooper, MD; Kevin A. Lawson, MD; Derek F. Amanatullah, MD, PhD; Cyril M. Hamad, Dipl Ing; Laurent D. Angibaud, Dipl Ing; and James I. Huddleston III, MD
The purpose of this study was to quantify femoral rotation in the axial plane for posterior-stabilized total knee replacements performed with a modified gap-balancing technique. In total, 2442 knees were selected from a computer-assisted orthopaedic surgery navigation system database. The knees were stratified into three groups based on preoperative coronal plane alignment. The computer navigation recorded distal femoral and tibial resection angles, and the rotational position of the femoral component. Means were calculated for each of the three groups. There was substantial variation of femoral axial rotation in all three groups. In aggregate, the mean rotational position for all knees was 2.4º external (-10.2º – 20.9º). The mean rotation for the varus group was 2.5º (-9.8º – 15.7º), 2.5º (-9.8º – 20.9º) for the neutral group, and 1.1º (-10.2º – 9.9º) for the valgus group (p < 0.0001). The data indicates that choosing a predetermined rotational position for the femoral component may lead to flexion gap asymmetry more frequently than by adjusting the rotational position intraoperatively to achieve a rectangular flexion space. This is the first study to quantify differences between varus and valgus knees related to flexion gap stability. Correlation of these findings to clinical outcomes is needed. There is no single rotational position for the femoral component that will produce a balanced flexion gap for every knee. There is a statistically significant difference between mean rotational position for femoral components for varus and valgus knees. (Journal of Surgical Orthopaedic Advances 34(4):193–195, 2025)
Key words: gap balancing, femoral componet rotation, flexion gap, knee instability
Impact of Tibiofemoral Compartment Gaps on Patient-reported Outcome Measures Following Robotic-assisted Total Knee Arthroplasty - Soham Ghoshal, BA; Adriana P. Liimakka, BS, MBI; Michael S. Roberts, MD; William Sorel, BS; Gavin W. Clark, MBBS, FRACS, PhD; Dermot M. Collopy, MBBS, FRACS; and Antonia F. Chen MD, MBA
This study explores the impact of tibiofemoral compartment gaps on patient-reported outcome measures (PROMs) following robotic-assisted total knee arthroplasty (RA-TKA). A retrospective review was conducted on 2,071 patients who underwent RA-TKA between April 2018 and January 2022. Patient demographic data, surgical data, intraoperative tibiofemoral gap measurements, and PROMs (Knee Injury and Osteoarthritis Outcome Score for Joint Replacement [KOOS JR], Visual Analogue Scale [VAS], Forgo!en Joint Score [FJS], and Oxford Knee Score [OKS] scores) were collected. Unadjusted analyses were conducted using Kruskal-Wallis and Mann-Whitney U tests. The mean postoperative medial flexion-extension (FE) gap delta was -0.3 mm, with only 0.6% of cases beyond two millimeters, whereas the mean lateral FE gap delta was 1.1 mm, with 16.1% of cases exceeding two millimeters. No significant PROM differences were observed between extreme quartile gap deltas. However, for one surgeon, patients with higher OKS scores had significantly smaller lateral FE gap deltas (p = 0.004). These findings suggest that differences in tibiofemoral compartment gaps following RA-TKA were not associated with clinically significant differences in PROMs. (Journal of Surgical Orthopaedic Advances 34(4):196–202, 2025)
Key words: total knee arthroplasty, robotic knee arthroplasty, patient-reported outcomes, tibiofemoral gap, Mako robotic surgery
Assessing the Influence of Body Mass Index and Tibial Prosthesis Design Characteristics on Survivorship in Total Knee Arthroplasty - Kristen I. Barton, MD, PhD; Alexandru Florea, BSc; Kevin R. Boldt, PhD; Clay Inculet, MD; Matthew G. Teeter, PhD; Lyndsay Somerville, PhD; and Brent Lanting, MD, MSc
The purpose of the study was to determine the relationship between increased body mass index (BMI) and tibial prosthesis characteristics. A retrospective analysis of total knee arthroplasties (TKAs) was completed, and a Cox multivariate regression was performed. In total, 8,548 TKAs were completed, and cumulative survivability was 98.0% at 5 years and 97.1% at 10 years. Age < 70 years (p < 0.01), male sex (p < 0.01), and BMI ≥ 40 kg/m2 (p = 0.04) were significantly related to revision in all implants. Implant type, contact surface area, base plate surface area, and tibial stem length did not have a statistically significant effect on implant survivability (p = 0.62 – 0.91). When stratified based on BMI, there was a significant decrease in survivability for those BMI ≥ 40 kg/m2 (p < 0.01). Patients with high BMI do not necessarily require larger implants, and surface area and stem length do not affect survivability. Patient factors appear to drive survivability outcomes after primary TKA more than the implant factors. (Journal of Surgical Orthopaedic Advances 34(4):203–206, 2025)
Key words: total joint arthroplasty, body mass index, implant, tibial component, stem length
A Decade of Racial Trends in Unicompartmental Knee Arthroplasty Utilization - Daniel Badin, MD; Andrew B. Harris, MD; Micheal Raad, MD; Claire McDaniel, MD; Suraj Dhanjani, BA; Vishal Hegde, MD; and Julius K. Oni, MD
The authors sought to examine the racial trends of relative unicompartmental knee arthroplasty (UKA) to total knee arthroplasty (TKA) utilization and complications over 10 years. The National Surgical Quality Improvement Program (NSQIP) database was utilized from 2010 to 2020. Adjusted incidence rate ratios (IRR) were derived for UKA:TKA among African American (AA), Asian, American Indian (AI), and Caucasian racial groups. Multivariate regression was used to compare complications; 406,684 patients were included. AA and AI patients underwent UKA at a lower rate than Caucasian patients (IRR = 0.42, 0.48, respectively, p < 0.001), while Asian patients underwent UKA at a higher rate (IRR = 1.4, p < 0.001). From 2010 to 2020, the IRR among AA patients decreased from 0.71 to 0.57 (p < 0.001), and the IRR for Asian patients increased from 0.38 to 2.07 (p < 0.001). There were no differences in complications. In conclusion, racial disparities in UKA utilization have widened over the past decade, despite similar rates of short-term complications after UKA. Level of Evidence: Prognostic – III. (Journal of Surgical Orthopaedic Advances 34(4):207–210, 2025)
Key words: disparities, race utilization, access, outcomes, arthroplasty, unicondylar